Eating Disorders Flashcards
What are the diagnostic features of anorexia nervosa?
- persistent restriction of energy intake leading to significant low body weight
- intense fear of gaining weight/behaviour interfering with weight gain
- disturbance in way one’s body weight/shaped is experienced
What are the subtypes of anorexia nervosa and their symptoms/actions done?
- Bulimic sub-type
- bingering
- vomiting
- laxative, diuretic abuse - Restrictive sub-type
- food restriction
- exercise
What are the diagnostic features of bulimia nervosa?
- recurrent episodes of binge eating characterised by: eating large amounts in discrete time OR lack of control during eating episode
- recurrent inappropriate compensatory behaviour to prevent weight gain
- behaviours above occur at least once a week for 3 months
- self-evaluation is unduly influenced by body shape/weight
- disturbance not occurring exclusively during episodes of anorexia nervosa
What are the subtypes of anorexia nervosa and their symptoms/actions done?
- Purging sub-type
- vomiting
- laxative, diuretic abuse - Non-purging sub-type
- food restriction
- exercise
What is the ratio of females to males, affected by Anorexia nervosa?
10:1
What is the community prevalence of AN?
0.4 to 100
Which types of people are more AN present in?
Dancers, gymnasts, athletes, models
What % of BN present in young females?
0.5-1%
Which has an older age onset, AN or BN?
BN (bulimia nervosa)
What other eating disorders are there?
- ARFID (avoidant restrictive food intake disorder) - undereat, but no body image problem
- PICA (eating non-nutrients)
- OSFED (other specific feeding and eating disorders)
- UFED (unspecified eating and eating disorder)
What are some clinical examination abnormalities in bulimia nervosa?
- tooth erosion
- calluses on knuckles
- enlarged parotids
- dehydration
- irregular pulse
What features tell you that from history, one had BN?
- loss of tooth enamel
- difficulty swallowing
- abdominal pain (IBS)
- gastric dilatation and rupture (rare)
- bowel disturbance (diarrhea, constipation, piled)
- absent/irregular menstruation
What are typical features in adults that show history of weight loss?
- loss weight/height
- amenorrhoea (absence of menstruation)
- loss sex drive
- weakness
- cold tolerance
- insomnia
- cyanosis, yellow skin
- lanugo hair (for insulation)
- constipation
- fractures
- infertility
What are typical features in children/adolescents that show history of weight loss?
- Failure to grow
- Failure to develop
What are some clinical examination abnormalities in bulimia nervosa?
- Emaciation
- Failure to grow
- Failure to develop
- Muscle weakness SUSS test
- Lanugo hair
- Dehydration
- Carotenosis
- Low blood pressure
- Slow pulse
- Low core temperature
In terms of biochemistry, what are some abnormal investigations found in AN?
- Urea usually down
- Urea, creatinine up if renal - failure or dehydration
- Sodium down in dehydration or water loading
- Glucose down
- potassium down if purging
- Mg, Phosphate down if refeeding
- Creatine Kinase (CK) up
- Liver function tests (Transaminase enzymes up)
- ECG (Any abnormality, T inversion, Prolonged QTc interval (>450ms))
How do you check bone mineral density thats abnormal in AN?
- using BMD or DEXA scan
- Hip and spine use X-rays
What is ovarian ultrasound used for?
- determine healthy weight
What can you tell at diff body weights, from ovarian ultrasound?
Low weight: no internal ovarian structure, small follicles
Medium weight: some internal ovarian structure, lots of large follicles (multifollicular phase)
Normal weight: Internal structure with one large dominant follicle diameter 15-22mm
At what BMD reading does one conclude that there’s osteopaenia?
1-2.5
At what BMD reading does one conclude that there’s osteoporosis?
<2.5
Explain what is hypokalaemia?
- low potassium
- vomiting (loss acid) = alkalosis
What can result from hypokalaemia?
- cardiac arrhythmia
- death
Why is there slow gut transit time in BN?
due to laxative abuse and low potassium
What is required when colon is dilated, inactive due to laxative abuse in BN?
colostomy
If upper GI endoscopy is done on BN patient, what could be shown?
- split oesophageal mucosa due to repeated vomiting, leading to haematemesis
What is the Mallory Weiss syndrome?
haematemesis from vomiting
What are signs of kidney failure in BN?
- raised urea and creatinine
- chronic hypokalaemia and dehydration
What percentage of AN recover?
47%
What percentage of people die with AN?
5%
What percentage of BN recover?
45%
What percentage of people die with BN?
0.3%
What is done to prevent eating disorders?
- programmes
- expert facilitators
- programmes inducing cognitive dissonance
Name the type of programmes:
- the Body Project
- Sorority Body Image Programme (US)
- Student bodies (US)
Treatment for AN:
- Principles of nutritional treatment (resuscitation, repair, repletion)
- Refeeding
- Family based Therapy (FBT)
- Cognitive Behavioural Therapy (CBT-E)
- Collaborative caring model (7 workshops)
What happens in FBT (family based therapy)?
- seen together or separately
- effective for patients 21 and under
- effective without hospitalisation
What happens in Cognitive Behavioural Therapy (CBT-E)? Explain the phases:
Phase 1: Increasing motivation to change.
Phase 2: If willing, regain weight and tackle eating disorder psychopathology
Phase 3: Helping develop personalized strategies for identifying and correcting any setbacks.
- 40 x 50 min sessions over 40 weeks
Treatment for BN:
- Cognitive Behaviour Therapy (CBT-BN)
- Interpersonal Therapy (IPT)
- Fluoxetine
What is the downside to interpersonal therapy?
takes longer time
How much fluoxetine is given?
60mg
Treatment for binge eating disorder:
- Cognitive Behavioural Therapy (CBT)
- Fluoxetine
- DBT
What is good of CBT and fluoxetine?
improves eating and doesn’t lead to weight loss
Should bariatric surgeons bother about eating disorder patients?
Yes
